WHO Monkeypox Update: 2103 Confirmed Cases, One Death, Across 42 Countries

Since the end of May, the World Health Organization (WHO) has been saying that the ongoing monkeypox outbreak poses “moderate risk” to the world. That’s lower than high risk, but higher than low. What’s moderate risk look like? Well, in only a week, the total number of laboratory confirmed monkeypox cases since the start of 2022 went from 1285 on June 8 to 2103 on June 15. That’s about a 64% jump, right after a similar one-week 65% jump from 780 cases on June 4. These numbers are from the latest WHO situation update on June 17.

Yes, the who, what, when, and how of it is that the World does have situation here. Cases have now spanned 42 countries and five different WHO regions, including many countries that rarely or never see monkeypox cases. Most (1773 or 84% of all cases) of these confirmed cases have been in the WHO European Region with the Region of the Americas coming in second with 245 or 12% and the African Region coming in third (64 or 3%). There’s been one death too in Nigeria.

This is probably just the tip of the monkeypox iceberg. Many cases may go unreported especially when symptoms are milder. Plus, while the WHO had provided suspected cases and deaths in previous situational updates, they will be “now focusing primarily on confirmed and probable cases, including deaths among confirmed and probable cases.” This may lead to further underestimation of the size and scope of the outbreak.

Now, just because the monkeypox virus has spread across multiple countries, don’t start using the p-word here (meaning “pandemic” and not any other p-word). This is not another pandemic for three big reasons. Unlike the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the monkeypox virus is not a novel to humans virus. It’s been infecting humans since 1971, albeit not a lot of humans. Your immune system may not be a complete virgin to this virus if you’ve gotten the smallpox vaccine previously since there is some similarlity between the smallpox and monkeypox viruses. Secondly, there needs to be clearer evidence of sustained transmission of the virus in multiple countries. Then there’s the third reason, even if sustained transmission is occurring, this is not a virus novel to human beings. Yes, this is the same reason as the first. But it’s important to emphasize that for something to qualify as a pandemic, the pathogen has got to be novel.

So far, of the cases from the 14 countries where demographic information is available, 99% have been men 65 years and younger, with the median age being 37 years. The WHO indicated that “most self-identify as men who have sex with other men.” But before the stigmatization gates open, keep in mind several things. Only 468 of the 2103 confirmed cases had demographic and other personal information available. Plus, reported and laboratory confirmed cases are typically only a fraction of all real cases. Who knows (meaning the pronoun and not the health organization) how many other cases are out there unreported and what their characteristics may be. Finally, the virus spreads via any type of close contact. It ain’t judgy like people can be.

This has been an unusual outbreak, not just because it’s the monkeypox. The cases have been unusual for monkeypox cases. My May 8 article for Forbes described the classic progression of symptoms, stating with fever and swollen lymph nodes then followed with the development of rashes that begin on the face before spreading to other parts of the body, particularly the extremities. Before this current outbreak, these lesions have tended to be synchronous, meaning that all lesions have been at the same stage at a given time whether they are in the flat rash, bump, fluid-filled vesicle, pustule, or scab stages. But for this current outbreak, the unusual presentations have included:

  • Lesions appearing before other symptoms like fever, fatigues, and swollen lymph nodes: This is a bit like jumping to the chorus of a song. .
  • Having only a single or a few lesions: Versus many more lesions.
  • Lesions just on the genitals or the perineal/perianal area: Typically, lesions will start on the face and then spread to other parts of the body, especially the extremities.
  • Lesions at different stages at the same time: Typically, all of the lesions will be at the same stage of development at a given time, being synchronous rather than asynchronous.

Speaking of genitals, the WHO is investigating whether sexual bodily fluids such as semen can transmit the virus, as I covered last week for Forbes.

Now just because this outbreak is of “moderate risk” doesn’t mean that the response will be the same as when your municipality indicates that the Covid-19 coronavirus is of “moderate risk.” Again, these are very different viruses. The WHO has indicated that the main monkeypox control measures remain surveillance, contact-tracing, isolation and care of patients. The WHO is currently not recommending mass vaccination witht he available smallpox vaccines. Instead, they are recommending vaccination for those at high risk for being exposed such as health care professionals who may be seeing patients with monkeypox, public health workers who may be investigating the outbreak, and laboratory personnel who may be working with the virus somehow. This would be considered pre-exposure prophylaxis against the monkeypox vaccine. Vaccination may be helpful for post-exposure prophylaxis (PEP) too: within four days of first exposure to the monkeypox virus. This can be up to 14 days when symptoms have not yet emerged. The WHO is also not recommending any particular travel restrictions due to the outbreak.

Once again, this monkeypox outbreak is by no means the same as the Covid-19 pandemic. It’s not going to prompt the same approach that was used for Covid-19. That doesn’t mean that you should monkeypox around, though. Don’t take unnecessary risks. Take precautions if someone around you may have been exposed to the monkeypox virus such as maintaining distance and encouraging the person to see a real medical doctor as soon as possible. And if you see some unexplained lesions on your friends, colleagues, or strangers, resist the urge to touch them.

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